Archive for January 2013

I’ve received some unhelpful advice in my time, but “eat less, move more” is hard to beat if you’re looking for unhelpful, yet superficially common-sense, advice.

For a start, “eat less, move more” is not a SMART goal because it’s not, in itself, specific or measurable. To be sure of eating less, you have to find a way of measuring what you’re already eating, and counting calories is probably the best way. (Measuring food by weight is an option too, but that has complications, given that 100g of treacle is probably more fattening than 100g of lemons.) And you can’t be sure you’re moving more unless you’re already tracking how much exercise you do. To be sure you’re really “moving more” – yup, you need a measurable activity programme.

All that would be fair enough, except for the fact that people always offer “eat less, move more” in a breezy spirit of brushing off complications and keeping things simple. It’s not simple. Monitoring your daily food intake and how much you exercise, on top of that little thing called a life, is actually not in the least easy or simple.

The hypocrisy of the “simples” vibe really comes to the fore when people dismiss counting calories/diets/the gym/planned exercise as tiresome activities to be replaced with the much easier plan to “eat less, move more”. Actually, those tiresome activities are a prerequisite of ensuring you eat less and move more.

Secondly, “eat less, move more” is not a SMART goal because it’s not attainable or realistic. OK, so let’s say I currently eat 2,000 calories a day and I’m overweight. So I “eat less” by cutting it down to 1,500 calories a day. I lose weight briefly before regaining most of it as my metabolism adjusts. What do I do when my “less” becomes the new norm and makes me fat again? Back to a new “less”, I guess. But where does that stop? There’s no limit to the notion of “less”, because there’s no measurability or actual numbers whatsoever in this shitty advice.

Similarly, there’s no measurability or end point to the concept of “moving more”. Do I keep going until I injure myself? Until I win an Olympic gold? Until I’m spending 24 hours of every day moving? Well… no. There’s no “until”. Just move more. Possibly the unspoken finish point for both “eat less” and “move more” is reaching your target weight. But what if you never reach it? Well, I guess that means you’re failing to follow this very simple advice and really only have yourself to blame for being fat.

People who tell you to “eat less, move more” don’t want to offer more specific or measurable advice because then they’d have to actually engage with the complexities of weight loss. They’d have to acknowledge that what works for one person doesn’t work for another, and that there’s a whole industry based on this stuff not working. They’d have to acknowledge that it’s possible to die from under-eating before you ever become underweight. They’d have to acknowledge their own privilege as thin people (or, more likely than not, acknowledge that they themselves are overweight because whaddya know, their own brilliant advice didn’t work for them). They’d have to say something different. Make themselves vulnerable. Take some initiative. And that’s never going to happen, because these people are lazy cowards without an original thought in their head.

If I did have to give some non-specific, vague, lazy advice of my own, it would be this: Take care of yourself, then of others. And remember that advice from people who don’t care about you is usually bad advice.

Roughly 42% of marriages in England and Wales are expected to end in divorce. You can use that as “proof” of many theories: marriage doesn’t work, heterosexual marriage doesn’t work, we’re marrying too late or too early, we’re marrying with unrealistic expectations… whatever. But whatever you use this to prove about marriage, you’d be wrong.

I’m not commenting on whether marriage can bring you happiness or a stable home life. But one thing it definitely can give you: a measurable starting point for a certain period in a relationship. The Office of National Statistics doesn’t know when you had your first kiss or went on your first holiday together. It doesn’t join in debates about whether it “counts” as a first date if you’re just meeting for coffee. But it does know when you got married. And it can take the group of people-who-got-married and measure that group for outcomes.

There’s no control group. If you want to measure whether marriage “works” in comparison to an unmarried control group, you can’t use people who haven’t committed at all as your control group – certainly not if your definition of “works” is about lasting commitments. So you’ll need to somehow find a definition of non-marriage-based commitment, find the people who’ve made that commitment and then measure their outcomes. The ONS doesn’t have the resources to shilly-shally about with that.

I’m not defending or attacking marriage here. I’m just saying that using statistics about marriage to draw conclusions about marriage itself is more complicated than you might think.

“I gave birth outside Waitrose.” The story is admittedly unusual enough to be featured in the Guardian magazine, but lots of these “I gave birth in [insert crazy location here]” stories seem to start in the same way.

Woman is having contractions. She thinks she’s giving birth. She travels to the hospital. The doctors tell her she’s “not far along enough” and send her home again. So someone who’s already travelled all the way to the hospital is forced to make a second journey home, in the knowledge that they’ll be making yet another journey back to the hospital later on. (And possibly a fourth journey home again, if they fail the test again, followed by a fifth journey back to the hospital, and so on.)

Hospitals are sending home women who are frightened, in pain, in no fit state to travel – and crucially – actually in labour. And they do it because the woman isn’t “far along enough”. Almost every woman I know who’s given birth in hospital has gone through the misery of travelling to the hospital and being sent home again before travelling back to finally receive medical help with her labour. I even know women who’ve been through the fourth and fifth journeys described above: to the hospital and home again, back to the hospital and home yet again, then finally back into hospital to give birth.

I’m no expert in childbirth or indeed in anything medical, and I’m happy to say I’ll never give birth myself. But it seems crystal-clear to me that the current system simply isn’t working. It isn’t working on a “basic human decency” level, because it causes so much misery and stress and pain to women in labour. And actually, it’s not working very well on a “getting patients care at the right time” level either. Hence the stories of women being sent home, then giving birth at home. Or in Waitrose. Or in the hospital waiting room. Or in a car on the motorway. Or in a lift.

OK, so if the current system for measuring “how far along” a woman is isn’t working, what system should we put in place instead? I keep saying I’m not a doctor, but I suspect the current system isn’t working because all labour experiences are different and there are no set-in-stone reliable indicators. So… why not go with what the person in labour actually wants? If she’s travelled to the hospital, and she’s in pain, and she’s frightened because she has no experience of this, and she wants help from trained medical staff, what’s the harm in keeping her in for observation?

The problem right now is that we’ve pared our medical service down to the bone. There’s no slack in the system for people who are maybe-giving-birth just to wait on a hospital bed; they’re taking up a bed that’s needed by someone who’s definitely-actually-giving-birth. There used to be some slack in the NHS that could be used for acts of kindness, like elderly people getting a lift home in a spare ambulance, or a nurse having time to chat to a lonely patient. Not any more, because we’ve “trimmed the fat” and “cut down on waste” and generally made our NHS mean and target-driven and unpleasant in the name of “efficiency”. What I’m saying is: does it really have to be that way? Couldn’t we imagine a world where we decided that trimmable fat was actually a good thing, because it creates jobs and gives us all a better experience of medical care? A world where you might be born to a mother who didn’t have several stressful hours of travel shortly before giving birth to you? I’d happily pay more tax for a national health service with slack in it, if it meant more kindness.

Why has no British soap ever run a storyline about domestic violence in same-sex partnerships? For the same reason that no British high-street store has a range of petite maternity clothing.

I’m entirely serious. The problem is: you’re not allowed to have two problems, or two identities. You can be a victim of domestic violence OR a lesbian. You can be small OR pregnant. Dealing with more than one non-mainstream situation at a time means acknowledging too much complicated reality at once, perhaps fighting too many battles at once.

I think that’s what’s going on when people dismiss intersectionality. “I’m trying to solve a problem here! I’m trying to HELP! Why are you nagging me about a different problem?”

Fear of intersectionality is why right-wingers joke about “one-legged black lesbians” and the like. They’re joking about people with more than one problem, people who belong to more than one minority group. The humour is an attempt to flatten the dimensions of a non-mainstream life, turning multiple identities into a set of tickboxes.

But, just as “rare cancers” make up 22% of all cancer cases, a minority identity is a very common thing to have. And I think that most people instinctively understand multiple identities, because how many of us really only possess one?

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